how do I explain this to pt

[cavityhereIcome]

Ok. I am a newbie to the clinic. This pt has several periapical lesions, and endo testing came out positive and pt has necrotic pulps. how do I best explain this situation so that patient choose to do endo? in other words, how do I sell this..

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[DrJeff]

I am a newbie to clinic. my pt has several periapical lesions, and endo testing shows they are necrotic. how do I explain this situation to patient so that he chooses to do Endo
? in other words, how do I sell this..?

Easy. Tell it like it is. They have pre-existing pathology (in general most patients will understand words like abscess or infection) Mention that (if so) the levels of the supportive bone around their teeth is good. Mention that the teeth are fully restorable once the infection/abscess is treated with root canal treatment and then a crown after for strength purposes.

The only other option to treat the infection/abscess is for the tooth/teeth to be extracted and then one should look into having the areas where teeth would then be missing restored so as to not put a greater amount of work forces on the remaining teeth trying to do the extra work that the infected teeth did.

If for various reasons the patient chooses to have the teeth out and not proceed with the endo/crowns, well then if you have informed them of the pros and cons of the various procedure options, then you have done your job. Don't get upset/frustrated if at times, patients won't choose to save a tooth. You may not be aware of all the factors in their lives at that time (or from past expereinces) that influence their choice.

Ultimately for many patients the major deciding factor will be "what will my out of pocket expense be?" and if the numbers don't make sense for them, the numbers don't make sense for them and it's nothing about your treatment plan presentation style

 

[Big Time Hoosier]

Ultimately for many patients the major deciding factor will be "what will my out of pocket expense be?"

This.

Big Hoss

 

[cavityhereIcome]

ok thank you so much for your advise!

 

[PerioDont]

I'd start with something like:

"looks like you have multiple teeth with large infections. There is the option of saving them, or removing them. Which would you like to pursue? We would strongly recommend getting some sort of treatment done to rid your body of the chronic infections.

Then let them talk

 

[oralcare123]

I usually say they have decomposing dead tissue inside their tooth

 

[Big Time Hoosier]

I usually say they have decomposing dead tissue inside their tooth

And it’ll be a $2,000 fix or a $100 fix. Which will it be...

Big Hoss

 

[oralcare123]

And it’ll be a $2,000 fix or a $100 fix. Which will it be...

Big Hoss

I don't do $100

 

[yappy]

Don't sell. Explain to them their treatment options, risks, benefits, advantages and disadvantages, for each, then answer their follow up questions so that they can make an informed decision. You're discussing matters concerning this persons health, be truthful and don't try to word-smith them into doing a procedure you want them to do.

 

[fit2]

Always helps to educate patient. You can show Xray and explain what healthy bone looks like. You can explain what radioLucency you is and what the dental treatments are.
I don’t like scaring patients but ultimately you gotta tell them hey this is an infection from your tooth that went into your jaw and you have an ongoing infection there which could cause greater problems like ostemyelitis etc. and you need to get rid of the source of the infection as well as take out the infection.

It’s hard when patients barely have money to make it to the school let alone get tx but your job isn’t to make the choices for them even if you care a lot. Just make sure patient understands what’s going on and don’t just slap oh we gotta either do root canal or take it out. Gotta be empathetic and feel for them potentially being in danger of losing a bunch of teeth.

It’ll get easier the more you do it. By end of dental school youll be comfortable explaining diagnoses and what needs to be done

 

[yappy]

Veracity is defined as being honest and telling the truth and is related to the principle of autonomy. It is the basis of the trust relationship established between a patient and a health care provider. Veracity is what binds the patient and the clinician as they seek to establish mutual treatment goals. Patients are expected to be truthful about their medical history, treatment expectations, and other relevant facts. Clinicians, for their part, must be truthful about the diagnosis, treatment options, benefits and disadvantages of each treatment option, cost of treatment, and the longevity afforded by the various treatment options. This allows patients to use their autonomy to make decisions in their own best interest. The obligation of veracity, based on respect for patients and autonomy, is acknowledged in most codes of ethics, including the codes of the ADA.

 

[oralcare123]

Don't sell anything. Make a treatment plan, including an option of no treatment. Let patient choose. If this teeth need restoration, tell them, that you wouldn't be able to do any treatment before they complete RCT

 

[schmoob]

The first question is are the teeth restorable? What is the cause of the infection? Is there significant bone loss? Are these true endo lesions? Are these root fractures? Is there traumatic occlusion?

You really need to have more information than some dark circles on a radiograph in order to make a proper diagnosis and appropriate treatment plans. This way you can have an answer in case the patient asks “how did this happen?”

 

[Rambunctious]

Ok. I am a newbie to the clinic. This pt has several periapical lesions, and endo testing came out positive and pt has necrotic pulps. how do I best explain this situation so that patient choose to do endo? in other words, how do I sell this..

when you say endo test came out positive can you explain that? I always thought "vitality" testing a necrotic tooth with cold would promote a negative/no response

 

[schmoob]

when you say endo test came out positive can you explain that? I always thought "vitality" testing a necrotic tooth with cold would promote a negative/no response

I think It’s pretty obvious OP is trying to say there are positive findings for pulpal necrosis.

 

[Rambunctious]

I think It’s pretty obvious OP is trying to say there are positive findings for pulpal necrosis.

Its not obvious when you use wrong or confusing terms to describe something. nice to see you again, i know you get antsy pants when you see my name on here